Carotid cavernous fistula is an abnormal communication between the cavernous portion of the carotid artery and the venous bed of cavernous sinus with secondary increased pressure in the cavernous sinus leading to clinical presentations depending on the vascular and/or nervous structures involved in this injury process. The patient may present in the emergency room with proptosis, cranial nerve palsy, increased intraocular pressure, diplopia, decreased vision, and sometimes blindness in case of a direct fistula between the carotid artery and cavernous sinus. This condition is secondary to a traumatic brain injury in the vast majority of cases. A spontaneous rupture of the carotid artery aneurysm into the cavernous sinus is a rare cause of the carotid-cavernous fistula. The aim of this study is to report a case of aneurysmal carotid-cavernous fistula revealed by a spontaneous right pulsatile exophthalmos and its successful management with arterial angiography and endovascular treatment at once.
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